The esophagus is separated from the stomach by a special muscular valve that allows the absorbed food to pass through and prevents it from returning. If the function of this valve is disturbed, a pathology occurs - gastroesophageal reflux. At the same time, gastric juice enters the esophagus, against which the mucous membrane of the esophagus has no protection, which means that various inflammations and burns occur on it.
Treatment of gastroesophageal reflux
Together with medications for the treatment of reflux, the doctor will probably advise you to do the following:
First of all, you need to get rid of excess weight, if you have one. The fact is that extra pounds put pressure on the stomach and push the acid back out of it. Even a few pounds lost can help relieve gastroesophageal reflux symptoms significantly.
Stop smoking when treating gastroesophageal reflux. This bad habit interferes with the production of a sufficient amount of saliva, which is essential for the stomach to function properly.
If you have reflux, do not wear tight or restrictive clothing. Oddly enough, it also provokes the appearance of heartburn.
Reduce the amount of fatty and stomach-burdening foods in your diet. She not only lies in the stomach for a long time, but also has the ability to move back. In addition, it relaxes the closing valve.
Switch to fractional meals during treatment. In other words, eat smaller portions more often. This will also help unload your stomach, and less acid will be produced.
Try to avoid eating spicy or stomach-irritating foods while treating gastroesophageal reflux. Also, avoid citrus and tomato juices. Chocolate and menthol sweets also provoke heartburn.
Make it a rule not to eat just before bed. When you go to bed, try to keep your head on a dais.
Gastroesophageal reflux symptoms
From time to time, symptoms of this reflux occur even in an absolutely healthy person or child. We are all familiar with it and in everyday life it is called ordinary heartburn.
If these symptoms of gastroesophageal reflux are one-off, then there is no particular danger. But when symptoms occur with regularity, they can lead to inflammation of the esophagus in its lower part, which is called gastroesophageal disease or GERD. But this disease, if started, can lead to serious consequences, such as Barrett's syndrome, inflammation of the esophagus or its narrowing, which may even require surgical intervention.
That is why, if you suffer from frequent heartburn or gastroesophageal reflux, it is high time to consult a gastroenterologist.
Gastroesophageal reflux is a violation of the functions of the lower esophageal sphincter, allowing the backflow of fluids from the gastrointestinal tract or food into the esophagus.
The varying degrees of severity of esophagitis are the result of prolonged contact of stomach acid, pepsin, trypsin, bile salts, and duodenal bicarbonate with the esophageal mucosa. The frequency of regurgitation and the composition of the regurgitated mass determine the severity of esophagitis. If only gastric acid acts, then this leads to moderate esophagitis, while combinations of stomach acid and pepsin or trypsin, bicarbonate and bile salts cause severe esophagitis. The risk of inflammation of the esophagus caused by regurgitation of gastric acid increases with repeated ingestions compared to a single prolonged acid reflux. There are few documented clinical cases of esophageal reflux, undoubtedly the disease is much more common than previously thought.
Causes
Chronic vomiting, impaired gastric emptying, esophageal opening and a decrease in the contraction of the esophageal sphincter caused by anesthesia are pathogenetic factors in the development of gastroesophageal reflux.
Diagnostics
Clinical signs... The clinical symptoms of gastroesophageal reflux are similar to those of esophagitis. In severe cases, patients may experience: regurgitation, drooling, dysphagia, stretching of the head and neck during swallowing, and unwillingness to eat. However, in less severe cases, sick patients may only have an occasional episode of regurgitation, especially in the early morning. Such cases occur as a result of the transition from the relaxed state of the esophageal sphincter during sleep. Physical examination of the patient usually does not give special results, but in patients with concomitant esophagitis in severe form, an increase in body temperature and hypersalivation can be detected.
Diagnostic imaging... Diagnosis of gastroesophageal reflux should be based on more than just clinical signs. Plain radiography is not informative. Intermittent gastroesophageal reflux can be detected on video fluoroscopy, but this phenomenon can also be observed in patients with normal esophageal function. Endoscopic examination is currently the best method for diagnosing mucosal inflammation associated with reflux esophagitis. A definitive diagnosis of esophageal reflux would require continuous measurement of the degree of contraction of the lower esophageal sphincter and 24-hour measurement of pH in the esophageal lumen, a procedure that most patients cannot tolerate. Hernia of the hiatus, esophagitis and narrowing of the esophagus are the most important diagnostic signs of reflux.
Treatment of gastroesophageal reflux
Because fat in food delays gastric emptying and reduces pressure in the lower esophageal sphincter, patients should be fed a diet that is limited in fat. Patient owners should also avoid feeding patients late at night, as this helps to relieve pressure in the lower esophageal sphincter during sleep. In addition to dietary advice, rational drug treatment for such disorders includes the creation of barriers to prevent diffusion of gastric contents (for example, use of sucralfate), the use of inhibitors of gastric acid secretion (for example, cimetidine, ranitidine, famotidine, omeprazole) and prokinetic drugs (for example , metoclopramide). The creation of barriers to prevent diffusion of gastric contents is perhaps the most important in the medical treatment of gastroesophageal reflux. Sucralfate, for example, protects the mucous membrane from damage from gastroesophageal reflux and promotes healing of present esophagitis. Resistant cases of reflux should also be treated with inhibitors of gastric acid secretion and / or prokinetic drugs. Antagonists of H, -receptors, such as cimetidine, ranitidine and famotidine, inhibit gastric acid secretion and reduce the amount of acid in reflux. Omeprazole (an inhibitor of H, K + adenosine triphosphatase (ATP)) can also be used to suppress gastric acid secretion. Low-dose erythromycin and metoclopramide may be effective in treating gastroesophageal reflux because they increase pressure in the lower esophageal sphincter. 5-hydroxytryptamine 4 (5-HT 4) agonists such as cisapride also increase the tone of the lower esophageal sphincter; however, the sale of cisapride has been banned by several international pharmaceutical companies.
Comments:
- Signs and causes of stomach reflux
- Some features
- Diagnosis and treatment of reflux disease
- Practical advice
A disease such as stomach reflux means that in the hollow organ of the digestive tract, the contents move through the sphincter back into the esophagus.
The thing is that the acidity shifts with this ailment, and if the mucous membrane is in contact with the acidic contents in the stomach for a long time and with the digestive enzyme, then inflammation occurs. Moreover, the so-called bicarbonates, which are located in the duodenum, can severely damage the mucous membrane. Therefore, in order to avoid serious consequences, this disease must be eliminated in a timely manner.
Signs and causes of stomach reflux
In some cases, reflux is considered a normal physiological manifestation. In particular, this may be the norm if it starts after a person has eaten, and at the same time this phenomenon does not cause discomfort, its duration and frequency are insignificant, especially when it comes to night time.
However, this ailment can also be painful, especially if it occurs quite often, and lasts for a long period of time, episodes of the disease can manifest themselves both during the day and at night, moreover, if such symptoms develop when the contents of the stomach are thrown into the esophagus, as clinical, inflammation occurs or the mucous membrane of the esophagus is damaged. This can happen due to the failure of the sphincter, with insufficient clearance or painful changes occurring in the stomach, which also increase the severity of reflux.
In addition, with this disease in patients, as a rule, decreased pressure in the esophageal sphincter. Experts have found that in order to maintain the tone of the sphincter, it is necessary to pay special attention to hormonal factors. Special medications and products are capable of reducing blood pressure. They develop and maintain reflux.
Due to the fact that the sphincter zone, which is located in the abdominal cavity, is located below the diaphragm, this prevents the reflux of stomach contents into the esophagus during inhalation. Under normal conditions, this compresses the lower segment of the esophagus, located among the legs of the diaphragm. If the patient develops a hernia, then the diaphragm is displaced, which prevents the evacuation of acidic contents.
The esophagus can contract, therefore, the natural cleansing of this organ from acidic contents is maintained, and intraesophageal acidity also returns to normal. There are several mechanisms due to which the esophagus is cleared, in particular, the prolonged activity of the esophagus itself, as well as a process such as salivation. If at least one of these phenomena is violated, then the level of cleansing of the esophagus decreases. This is often due to an alkaline or acidic substance.
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Some features
If we talk about signs, then reflux disease has a variety of symptoms, which, as a rule, are observed not only in isolation, but also in some combinations. It should be noted that these symptoms occur in 40% of residents from different parts of the world, and about 10% experience them every day.
The most pronounced manifestations are heartburn, pain felt behind the sternum and on the left side. chest, some suffer from frequent regurgitation, pain while swallowing, prolonged cough and deterioration of the condition of the tooth enamel.
However, it should be borne in mind that such manifestations do not fully reflect the severity of the disease. In many cases, reflux disease is not accompanied by any sensations.
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Diagnosis and treatment of reflux disease
Any changes that occur in the esophagus during reflux can be assessed by esophagoscopy with biopsy. She puts not only an assessment of the lesion of the esophagus, but also conducts differential diagnostics, and all this happens thanks to X-ray examination.
The monitoring of acidity itself takes 24 hours, it plays a very important role in making the correct diagnosis.
Treatment is primarily aimed at reducing the severity of the disease, reducing those properties of the contents of the stomach that affect the state of health. In addition, it is necessary to improve the cleansing of the esophagus and to protect the mucous membrane.
At the same time, it is important to follow the general rules that can reduce the severity of the throwing of contents in the stomach directly into the esophagus. First of all, this is the normalization of the patient's weight (in patients who are overweight, indicators often improve if they follow the correct diet). In addition, it is necessary to stop smoking and try to take less alcoholic beverages, limit yourself to the use of fatty foods, sweets such as chocolate, it is forbidden to drink coffee, since it is these products that reduce the tone of the sphincter, and fatty foods also reduce the activity of the stomach.
Sour food will also have to be abandoned, because it can cause such an unpleasant phenomenon as heartburn.
Food should be taken in small portions, it should be done regularly.
You should not eat food at night; you should eat it no later than 2 hours before going to bed. Excessive exertion should also be avoided, since they increase intra-abdominal pressure.
If such preventive measures do not bring any benefit, then the doctor prescribes antacids. So called medicationswhich contain magnesium, aluminum salt and calcium. They neutralize hydrochloric acid. In addition to this action, they have a binding effect, thanks to them there is a decrease in the digestive enzyme of gastric juice, lysolecithin and bile acid.
The best effect on the disease is drugs in the form of gels. In the esophagus, stomach, this agent secretes small drops, which enhance the effect of the drug.
Antacids should be taken half an hour before meals, and this should also be done before the patient goes to bed. It is recommended to take the product in a supine position, this should be done in small sips. If antacids do not bring an effect and the signs continue to progress, then the patient is prescribed prokinetics or antisecretory agents. In the case of prokinetics, domperidone is prescribed for patients with reflux. This drug should be consumed at 10 mg, it should be done 4 times during the day.
If the patient has erosive esophagitis, then additional treatment is prescribed. The most commonly prescribed drugs are rabeprazole and omeprazole.
As a result, they all have gastroesophageal reflux (because vomiting is exactly that: throwing stomach contents back into the esophagus). It takes place about a year.
Some children have gastroesophageal reflux disease, a real condition that causes esophagitis or breathing problems. In these cases breast-feeding especially indicated because milk shortens the duration of reflux emissions.
In contrast to breast milk, eating thicker foods (such as antireflux mixtures with thickeners) does little to prevent reflux.
What will it be about?
The fact that sometimes food returns from the stomach through the esophagus back into the baby's mouth. In the first months of a baby's life, it is milk, later - and thick food. In other words, the process is opposite to the natural one. Usually, the product that you gave the child through the mouth enters the esophagus, from there it goes down into the stomach, then follows its path through the intestines, where digestion ends. But with gastroesophageal reflux, not everything that the child ate is thrown back: part of the food is still absorbed and digested.
If in a child in the first months of life, a non-closure of the cardia (the opening that separates the esophagus from the stomach) is found, gastroesophageal reflux is observed especially often, and its manifestations are quite diverse. Sometimes he discovers himself with profuse regurgitation, more like vomiting: the child literally starts gushing out of his mouth, he should start eating, and it happens that some time later after that. And sometimes it is outwardly almost invisible: the returning food reaches only a third or to the middle of the esophagus in height, and you can only find out that a child has gastroesophageal reflux by the way he cries from pain caused by penetration into an unprotected from acid esophagus acidic stomach contents.
In addition to regurgitation, vomiting and crying, gastroesophageal reflux can also manifest itself as difficulties experienced by a baby who wants to burp and is unable to burp, or, conversely, in an overly sonorous and frequent belching, both during feeding and after it.
Finally, a dry, slightly hoarse cough can sometimes be a manifestation of reflux. The baby begins to cough immediately after eating or some time after it, mainly when he is placed in a stroller or crib
When can a child be suspected of having gastroesophageal reflux? When a child spits up or cries bitterly after feeding several times a day. And also - when he wakes up a quarter of an hour or half an hour after feeding and begins to cry or burp. In addition, the presence of reflux in a baby can be suspected if he wakes up at night, spits up or even just wakes up often at night, and he feels that he is experiencing some kind of discomfort. With reflux, the baby often coughs at night, and attacks of dry cough always occur at the same hours.
If a child in the first months of life has attacks of completely obvious ailments such as lightheadedness, this makes one think about the presence of gastroesophageal reflux. What are the signs of childhood malaise? As a rule, the baby turns pale, stops moving his arms and legs, his gaze seems to stop or clouded over. This type of malaise is very disturbing for parents who think that this is a manifestation of some very serious illness.
If the lying child begins to cough, and this cough is also accompanied by mild regurgitation, again it is necessary to check if he has gastroesophageal reflux. Ditto for a nocturnal cough.
If in the first months of life the baby regularly wakes up at night crying, and this happens at 23-24 hours, as well as at 3-4 hours, it is worth considering whether the child has gastroesophageal reflux.
Recurrent otitis media, as well as some types of bronchitis, suggest that gastroesophageal reflux is to blame.
Treatment of gastroesophageal reflux
There is no need to treat the child if we are talking about small regurgitation, which does not occur constantly, but only sometimes and is well tolerated, without crying. When a baby eats with pleasure, behaves completely normally, he does not have any disturbances in digestion, or in the duration and quality of sleep, there is nothing to worry about. Conversely, if the child spits up often (all the more - constantly) and profusely, if at the same time there are difficulties with belching, you need to immediately take action. First of all, you should replace ordinary milk with condensed milk, which the doctor will recommend to you, and most importantly, keep the child's upper body elevated: for this, you need to put something under the mattress at the head of the bed so that it is 20-30 degrees higher (this will prevent milk from returning from the stomach into the mouth). If you have sufficient funds, you can even buy a special antireflux mattress that allows your baby to sleep in an almost upright position.
If spitting up and vomiting is accompanied by crying, do not hesitate for a minute, take your child to the doctor. If the diagnosis of gastroesophageal reflux is confirmed, the pediatrician will advise you not only to raise the head of the mattress, switch to condensed milk and apply a special bandage on the tummy after feeding (thanks to it, the child will not feel pain if acid enters the esophagus from the stomach), but also may prescribe medication that will speed up the passage of food through the esophagus into the stomach and further into the intestines. Naturally, all of the above relates to the field of symptomatic treatment, because reflux is not a disease, but a consequence of small mechanical abnormalities (food, instead of going down, rises up).
Another situation may arise that deserves special attention. Imagine a case where symptomatic treatment is not enough to improve the condition of the child and return him to normal well-being, and therefore behavior. If the baby, despite all the measures taken, continues to cry, does not sleep well (or does not sleep at all), you understand that he is in pain. This situation makes you think: does the child have inflammation of the esophagus (esophagitis)? Inflammation can be triggered by the constant penetration of acidic contents from the stomach into the esophagus, the walls of which are very delicate and unprotected.
In this case, the doctor will suggest an additional examination to see the inside of the esophagus. This examination is called esophageal fibroscopy or endoscopy. It consists in the fact that a special probe is inserted into the esophagus through the mouth, a special device at the end of which makes it possible to transmit to the monitor information about the state of the esophageal walls. Another very thin probe examines the acidity in the lumen of the esophagus. The probe, lowered to the level of the stomach, allows you to register acidity rises over several hours or even days. If, as a result of these studies, the diagnosis of inflammation of the esophagus due to reflux is confirmed, then with a high degree of probability it can be assumed that in the future, therapy will be applied designed to reduce the level of acidity, i.e., to reduce the negative effect of gastric juice on the esophagus.
X-ray examination of the passage of food from the esophagus through the stomach into the duodenum, which is done only after a long ineffective treatment of gastroesophageal reflux, makes it possible to reveal a significant anomaly of the entrance to the stomach. In this case, we are talking about a hernia of the esophageal opening of the diaphragm, that is, a hernia located in the region of the upper part of the stomach, which is located in the chest.
Gastroesophageal reflux often disappears with the introduction of complementary foods, when the baby's food becomes more varied, or by 6-8 months, when the baby begins to feed in a sitting position. But much more often gastroesophageal reflux disappears only by the end of the first year of a child's life.
If the symptoms characteristic of reflux appear in the second year of a baby's life, you should think about whether he has a serious congenital malformation or a developmental malformation in which part of the stomach is located within the chest. In this case, surgical intervention is most often suggested.
What to avoid ...
To believe that if the baby continues to spit up even when antireflux therapy is already underway, then the treatment is ineffective.
Symptomatic treatment is carried out with only bandages and compresses. They reduce the force of the acid rising from the stomach on the walls of the esophagus, make it easier for the child to tolerate reflux and accelerate the "unloading" of the stomach. In addition, if treatment is accompanied by a switch to condensed food, it becomes easier for the baby to swallow the food.
It is unnecessary to "heal" a child when reflux is well tolerated and symptoms are practically absent.
Require the doctor to prescribe additional studies.
This will not change anything in the development of gastroesophageal reflux, on the contrary, it can only complicate the child's life, because his condition will become more difficult. Indications for additional studies may appear only if the effect of therapy is insufficient, especially if there is pain, cough, etc.
Abruptly discontinue antireflux treatment (regardless of the opinion of the doctor) when symptoms are severe enough.
Confirm that the child has gastrointestinal reflux if he vomits all day.
It is quite possible that this is a manifestation of a completely different disease, so it is best to see a doctor right away.
Gastroesophageal reflux is not a disease, but a violation of the normal mechanical process of food passage through the digestive tract. As a rule, reflux passes (the process of food intake into the stomach is getting better) by the end of the first year of a child's life. How soon the reflux will be ended depends on the severity of this pathology and on whether it is associated with some anatomical anomaly.
Usually uncomplicated reflux disappears when a 4-5 month old baby is fed a variety of, mostly thick, foods. If at this time the reflux phenomena do not disappear, one can hope that this will happen when the child learns to sit well, that is, by 6-8 months.
Narrowing of the pylorus (pyloric stenosis)
The gatekeeper is the channel through which a portion of food descends from the stomach into the duodenum, to the beginning of the small intestine. Narrowing of the pylorus (doctors call this pathology pyloric stenosis) is a thickening of the muscles that "serve" the outlet of the stomach. In a normal state, it allows food to pass from the stomach to the intestines, where its digestion and absorption continues, and in a narrowed (stenotic) state, this transition is difficult.
This malformation (and it is observed mainly in boys, and mainly in overly "muscular") is expressed in the fact that the progressive narrowing of the pylorus increasingly interferes with the passage of food from the stomach into the intestine, as a result, food stagnates in the stomach, and this causes bouts of vomiting (food goes in the opposite direction).
Symptoms of narrowing of the gatekeeper may appear around the 15th day of a child's life, but much more often they appear by the end of the first month: you notice that the child wants to eat, but cannot, because he immediately gives back what he has eaten, that he is losing weight all the time cries from hunger and is tormented by constipation. The kid literally pounces on the milk, but after the first sips, vomiting immediately begins.
The diagnosis is made by a physician based on symptoms and confirmed by an ultrasound examination of the abdomen (echography) or X-ray examination of the digestive tract. Further, surgical intervention is required. The operation is not difficult: the muscle is slightly incised, which ensures the expansion of the outlet of the stomach to its normal size.